In general, there are three types of images an otolaryngologist (ENT) practitioner would use to help make and examine a diagnosis: ultrasound, CT, and MR. Most of the time, your ENT can make the diagnosis based on your history and the physical exam, but there might come a time where radiology or imaging studies are necessary to confirm or make the diagnosis. An ultrasound, or “sonogram”, is an essentially no-risk tool that a technician uses as a probe in the hand to apply slight pressure and examine the way sound waves bounce into and through and back at the same probe. One might think of what is applied to a pregnant abdomen: that is an ultrasound. In otolaryngology, the U/S (ultrasound) is usually used for the neck, although some studies are being done on sonography use for the sinuses and throat. A computed tomography, or CT scan, is used to look into areas that are under the skin, being the best at seeing bones by using X-ray technology. It was also called a “CAT scan”, with the A standing for axial. In otolaryngology, the CT scan is used most commonly for the sinuses and middle ear without contrast (contrast means using an intravenous “IV” line to inject a type of dye). Rarely do we use dye to look at the sinuses or middle ear. For the neck, we often do use dye or contrast, since that is still the gold standard to see all of the neck anatomy. The risk of CT is primarily radiation exposure, although nowadays this is very small compared to the first CT scanners.
A magnetic resonance image, or MR / MRI, is used to see the soft tissue. The technology being used to generate an image is based on magnets, which makes it not something that can be used for those with ferromagnetic implants or batteries (e.g. pacemakers and such). Many do not know that it is a rare day at hudsonENT that we do not order an MR. The vast majority of the time, we are looking to “see into the inner ear”, since there is no better way. And we typically ask patients to get bloodwork before this special test, called “MRI with and without gadolinium, of the brain and IAC’s”. We are looking at the internal auditory canals to determine the reasons why someone might have a hearing problem or balance difficulties. Sometimes, MR is used for the neck and sinuses as well. The risk of MR is claustrophobia, and there is no radiation here.
Research is being done on using any of these three elsewhere in the head and neck, and one should know that other radiology-type imaging is also being used in our field. For example, PET-scans, direct optical imaging, nuclear medicine, angiography, and many more exist and are being studied to help you. If you have concerns about your upcoming radiography tests, or think you might need a test to “look deeper”, give us a call at 845-758-1456.